Nitazenes Overdose Crisis: The New Synthetic Opioid Fueling a Public Health Emergency

A new wave of synthetic opioids called nitazenes is driving a surge in fatal overdoses across the United States. These drugs are significantly more potent than fentanyl and are increasingly being found in the illicit drug supply. Public health officials are warning of a growing crisis as these substances appear in everything from heroin to counterfeit pills.

According to reports from the United Nations Office on Drugs and Crime, the global presence of nitazenes has been climbing steadily for the past five years. Their emergence represents a severe and escalating threat to communities already grappling with the opioid epidemic.

What Are Nitazenes and Why Are They So Dangerous?

Nitazenes are a class of potent synthetic opioids first created in the 1950s. They were developed as potential painkillers but were never approved for medical use. Their extreme potency and high overdose risk prevented their adoption.

These drugs act on the brain’s opioid receptors similarly to fentanyl or heroin. They cause effects like euphoria, sedation, and severe respiratory depression. The key difference is their staggering strength.

The most common nitazene, isotonitazene, is five to nine times stronger than fentanyl. Fentanyl itself is up to fifty times stronger than heroin. This means a minuscule amount of nitazene—less than 2 milligrams—can be lethal.

The Alarming Spread and Public Health Impact

Nitazenes are now appearing in drug supplies nationwide. They are being mixed into other substances without users’ knowledge. This makes every drug use event potentially fatal.

Data from the Ohio Department of Health shows the rapid escalation. The state reported seven nitazene-related deaths in 2020. This jumped to an average of 57 deaths in 2021 and 2022. Tennessee recorded 92 nitazene-involved fatalities between 2020 and 2023.

Enforcement is challenging because new nitazene variants constantly emerge. When one compound gets banned, manufacturers slightly alter its chemical structure. This creates a new, technically legal version that continues the cycle of danger.

Thought you’d like to know

What are the signs of a nitazene overdose?

Signs mirror other opioid overdoses. They include extreme sleepiness, slow or stopped breathing, and unresponsiveness. The skin may feel cold and clammy, and lips or fingernails might turn blue.

Does naloxone work against nitazenes?

Naloxone can reverse a nitazene overdose. However, their extreme potency often requires multiple doses. First responders should administer naloxone repeatedly until the person responds.

Can drug tests detect nitazenes?

Standard fentanyl test strips do not detect nitazenes. Most hospital toxicology panels also miss them. This leads to underreporting of overdoses and deaths related to these substances.

Who is most at risk from nitazenes?

Anyone using illicit drugs faces risk. Nitazenes are found in counterfeit pills sold as other medications. They also appear in heroin, cocaine, and other street drugs, affecting users who never intended to take opioids.

Why are drug dealers adding nitazenes to their supply?

Nitazenes are inexpensive and extremely potent. Dealers use them to stretch their supply and increase profits. Their strength also creates highly addictive products, ensuring repeat customers.